Mohamed is a 30-year-old male from Al-Aqiq. Two years ago, he presented to Al-Aqiq Hospital suffering from nasal itching, sneezing, and mild fever. Dr Nowaf examined him and found that his nose appeared pale, the nasal mucosa was congested, and inferior turbinates were enlarged. Otoscopic examination revealed red, bulging tympanic membrane in the left ear. Based on these findings, Dr Nowaf prescribed an oral antibiotic, antipyretic, and nasal decongestant. One month following his first visit, Mohamed returned with scanty, offensive, mucopurulent discharge of the left ear. The discharge was associated with severe ear pain, hearing loss, tinnitus, and vertigo. On examination, there was a visible large posterior perforation in the tympanic membrane at the attic area with edematous mucosa of the middle ear, granulation tissue, and aural polyp protruding through the perforation. The doctor conducted good aural toilet and requested a computed tomography (CT) scan of the left mastoid bone. The CT showed a cavity within the mastoid. Two weeks later, Mohamed underwent surgery of his left ear and mastoid bone where some tissues were removed and another tissue was added. Mohammed felt good, and his hearing was restored.

At the end of the PBL session, the students will be able to:

1. Revise the anatomy and histology of the middle ear

2. Identify the etiology, clinical picture, and investigations required

4. Design the management plan for chronic and acute otitis media

5. Be aware of the risk factors, epidemiology, prevention, and control of acute and chronic otitis media.

An example of question applied

Which of the following diagnostic techniques is the most essential for otitis media?

a) Pneumatic otoscopy

b) Tympanometry

c) Tympanocentesis

d) Acoustic reflectometry.

Abbreviations: ENT, ear, nose and throat; PBL, problem-based learning.